Introduction. One of the most common complications of endovascular repair of
abdominal aortic aneurysm is type II endoleak - retrograde branch flow. Case
report. A 76-year-old man with abdominal aortic aneurysm, 7. 1cm in diameter
and aneurysm of the right common iliac artery, 3. 2cm in diameter was
admitted to our Department with abdominal pain. The patient had no chance of
having open repair of abdominal aortic aneurysm because of high perioperative
risk (cardiac ejection fraction of 23%, chronic pulmonary obstructive
disease). Multislice computed angiography also revealed a large inferior
mesenteric artery, 6mm in diameter with the origin in thrombus of aneurysm.
We decided to repair abdominal aortic aneurysm with GORE? EXCLUDER ?
stent-graft with crossed right hypogastric, but first we decided to embolize
the inferior mesenteric artery. Angiography was performed through the right
femoral approach and the good Riolan arcade was found. After that the
inferior mesenteric artery was embolized with two coils, 5 mm in diameter, at
the origin of artery in aneurysm thrombus. At the end of procedure, abdominal
aortic aneurysm was repaired with GORE? stent-graft, and the control
angiography was performed. There was no endoleak, and the Riolan arcade was
very good. The patient was discharged after 5 days. There were no signs of
ischemia of the left colon, and peristaltic was excellent. Control multislice
computed angiography was done after 1 and 3 months. There were no signs of
endoleak. On the control colonoscopy there were no signs of ischemia of the
colon. Conclusion. Endovascular repair of symptomatic abdominal aortic
aneurysm in high risk patients with preoperative embolization of large branch
is the best choice to prevent rupture of abdominal aortic aneurysm and to
prevent type II endoleak.
Intrathrombus embolization of giant mesenteric inferior artery to prevent type II endoleak